I saw two patients on the morning that I received an invitation from the British Association of Spinal Surgeons (BASS) Executive to write an editorial based on a memorable article. Both in their 30s, they were seeking second opinions. The first had undergone a four-level anterior cervical fusion using interbody cages and an anterior cervical plate 3 years previously. Plain cervical radiographs demonstrated an excellent technical result. However, flexion and extension views revealed excessive movement at C2–C3 with a minor anterolisthesis. The patient, crippled by neck pain and occipital neuralagia, had been unable to work for more than 18 months. I was informed that the surgery had been undertaken to prevent paralysis. The preoperative cervical magnetic resonance imaging scan showed trivial anterior thecal impressions in the mid and lower cervical spinal canal. The second patient had a relapsing lumbar radiculopathy with leg pain and a motor weakness in the absence of any structural back pain due to a small extruded disc fragment in the subarticular recess. The patient had been offered an instrumented anterior lumbar interbody fusion at a private hospital on the understanding that a simple discectomy to be undertaken as an National Health Service (NHS) patient would result in disabling low back pain. The patient was anxious to establish whether disc replacement would be a better option . More than 20 years ago, I was young consultant enthusiastically embracing the spinal revolution. I was of the generation brought up on Harrington and Luque rods; Hartshill bridges and Ransford loops; sublaminar wiring and hooks; Cloward cervical instrumentation; and anterior spinal plates cobbled together from trauma sets. Then, suddenly it seemed, we had pedicle screws; lateral mass screws; anterior cervical locking plates; interbody and vertebral cages; and Kaneda anterior rod-screw implants: instrumentation that really worked! Returning from Steffee’s spinal instrumentation course in the United States, I was reviewing the literature on